Impact of Routine Platelet Reactivity Testing with VerifyNow Assay on Antiplatelet Choice After Percutaneous Coronary Intervention

Fakilahyel S Mshelbwala, Daniel W Hugenberg, Rolf P Kreutz Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USACorrespondence: Rolf P KreutzKrannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 4620...

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Autores principales:	Mshelbwala FS, Hugenberg DW, Kreutz RP
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	clopidogrel prasugrel ticagrelor myocardial infarction Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/27a02000a6014ec2bc26522c37139402
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spelling	oai:doaj.org-article:27a02000a6014ec2bc26522c371394022021-12-02T10:11:25ZImpact of Routine Platelet Reactivity Testing with VerifyNow Assay on Antiplatelet Choice After Percutaneous Coronary Intervention1179-1438https://doaj.org/article/27a02000a6014ec2bc26522c371394022020-04-01T00:00:00Zhttps://www.dovepress.com/impact-of-routine-platelet-reactivity-testing-with-verifynow-assay-on--peer-reviewed-article-CPAAhttps://doaj.org/toc/1179-1438Fakilahyel S Mshelbwala, Daniel W Hugenberg, Rolf P Kreutz Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USACorrespondence: Rolf P KreutzKrannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USAEmail rkreutz@iu.eduBackground: High on-treatment ADP platelet reactivity (HPR) measured by VerifyNow P2Y12 assay (VN) is an established risk factor for ischemic events after percutaneous coronary intervention (PCI). We hypothesized that routine use of VN at time of PCI in clinical practice may affect choice of P2Y12 antiplatelet therapy at discharge.Methods: In a single center retrospective analysis, we examined the influence of VN testing on choice of P2Y12 inhibitor post PCI in routine clinical practice. Assessment of HPR was used routinely in clinical care during the time period of analysis at discretion of clinical providers. Subjects with PRU> 208 after the loading dose of clopidogrel or during clopidogrel steady state were switched to alternate P2Y12 inhibitors.Results: We identified 1001 patients with PCI during the time period specified. A total of 252 subjects underwent VN testing. Among those, 43% were found to have HPR on clopidogrel and were switched to alternate therapies (prasugrel [n=60], ticagrelor [n=48]). Patients who had VN platelet function testing were more likely to be discharged on clopidogrel as compared to those who did not have VN assay done (57% vs. 50%, p=0.039). There was no significant difference in 1-year net-MACE (CVD, MI, stent thrombosis, BARC 2 or higher bleeding) using tailored antiplatelet therapy (VN testing) as compared to standard of care group (adjusted HR:0.92, 95% CI: 0.54– 1.5, p=0.74).Conclusion: Routine use of VN assay in personalized antiplatelet treatment decision-making after PCI is associated with lower likelihood of using novel P2Y12 inhibitors.Keywords: clopidogrel, prasugrel, ticagrelor, myocardial infarctionMshelbwala FSHugenberg DWKreutz RPDove Medical Pressarticleclopidogrelprasugrelticagrelormyocardial infarctionTherapeutics. PharmacologyRM1-950ENClinical Pharmacology: Advances and Applications, Vol Volume 12, Pp 35-41 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	clopidogrel prasugrel ticagrelor myocardial infarction Therapeutics. Pharmacology RM1-950
spellingShingle	clopidogrel prasugrel ticagrelor myocardial infarction Therapeutics. Pharmacology RM1-950 Mshelbwala FS Hugenberg DW Kreutz RP Impact of Routine Platelet Reactivity Testing with VerifyNow Assay on Antiplatelet Choice After Percutaneous Coronary Intervention
description	Fakilahyel S Mshelbwala, Daniel W Hugenberg, Rolf P Kreutz Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USACorrespondence: Rolf P KreutzKrannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USAEmail rkreutz@iu.eduBackground: High on-treatment ADP platelet reactivity (HPR) measured by VerifyNow P2Y12 assay (VN) is an established risk factor for ischemic events after percutaneous coronary intervention (PCI). We hypothesized that routine use of VN at time of PCI in clinical practice may affect choice of P2Y12 antiplatelet therapy at discharge.Methods: In a single center retrospective analysis, we examined the influence of VN testing on choice of P2Y12 inhibitor post PCI in routine clinical practice. Assessment of HPR was used routinely in clinical care during the time period of analysis at discretion of clinical providers. Subjects with PRU> 208 after the loading dose of clopidogrel or during clopidogrel steady state were switched to alternate P2Y12 inhibitors.Results: We identified 1001 patients with PCI during the time period specified. A total of 252 subjects underwent VN testing. Among those, 43% were found to have HPR on clopidogrel and were switched to alternate therapies (prasugrel [n=60], ticagrelor [n=48]). Patients who had VN platelet function testing were more likely to be discharged on clopidogrel as compared to those who did not have VN assay done (57% vs. 50%, p=0.039). There was no significant difference in 1-year net-MACE (CVD, MI, stent thrombosis, BARC 2 or higher bleeding) using tailored antiplatelet therapy (VN testing) as compared to standard of care group (adjusted HR:0.92, 95% CI: 0.54– 1.5, p=0.74).Conclusion: Routine use of VN assay in personalized antiplatelet treatment decision-making after PCI is associated with lower likelihood of using novel P2Y12 inhibitors.Keywords: clopidogrel, prasugrel, ticagrelor, myocardial infarction
format	article
author	Mshelbwala FS Hugenberg DW Kreutz RP
author_facet	Mshelbwala FS Hugenberg DW Kreutz RP
author_sort	Mshelbwala FS
title	Impact of Routine Platelet Reactivity Testing with VerifyNow Assay on Antiplatelet Choice After Percutaneous Coronary Intervention
title_short	Impact of Routine Platelet Reactivity Testing with VerifyNow Assay on Antiplatelet Choice After Percutaneous Coronary Intervention
title_full	Impact of Routine Platelet Reactivity Testing with VerifyNow Assay on Antiplatelet Choice After Percutaneous Coronary Intervention
title_fullStr	Impact of Routine Platelet Reactivity Testing with VerifyNow Assay on Antiplatelet Choice After Percutaneous Coronary Intervention
title_full_unstemmed	Impact of Routine Platelet Reactivity Testing with VerifyNow Assay on Antiplatelet Choice After Percutaneous Coronary Intervention
title_sort	impact of routine platelet reactivity testing with verifynow assay on antiplatelet choice after percutaneous coronary intervention
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/27a02000a6014ec2bc26522c37139402
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Impact of Routine Platelet Reactivity Testing with VerifyNow Assay on Antiplatelet Choice After Percutaneous Coronary Intervention

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